Provider Demographics
NPI:1689389272
Name:JACOBS, JERROLD ALAN
Entity Type:Individual
Prefix:
First Name:JERROLD
Middle Name:ALAN
Last Name:JACOBS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3030 GUILDFORD B
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33434-4866
Mailing Address - Country:US
Mailing Address - Phone:585-200-8553
Mailing Address - Fax:
Practice Address - Street 1:3030 GUILDFORD B
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33434-4866
Practice Address - Country:US
Practice Address - Phone:585-200-8553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-18
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical